反复单形性特发性室速发作前的心率变异性分析  

Analysis of heart rate variability before the onset of repetitive monomorphic idiopathic ventricular tachycardia

作　　者：郭冰丽[1] 张树龙[2] 洪丽[1] Guo Bing-li;Zhang Shu-long;Hong Li(Department of Cardiovascular Examination,the First Affiliated Hospital of Dalian Medical University,Dalian Liaoning 116011;Department of Cardiology,the Affiliated Zhongshan Hospital of Dalian University,Dalian Liaoning 116001,China)

机构地区：[1]大连医科大学附属第一医院心血管检查科,辽宁大连116011 [2]大连大学附属中山医院心脏中心,辽宁大连116001

出　　处：《实用心电学杂志》2018年第3期178-181,共4页Journal of Practical Electrocardiology

基　　金：国家自然科学基金资助项目(81370307)

摘　　要：目的研究反复单形性特发性室速(repetitive monomorphic idiopathic ventricular tachycardia,RMIVT)患者室速(ventricular tachycardia,VT)发作前交感和迷走神经的平衡状态。方法记录20例RMIVT患者的动态心电图,分析56阵短阵室速(室速发作前窦律至少维持1 h)发作前30 min每5 min的心率变异性(heart rate variability,HRV)各指标的动态变化。结果室速发作前30 min全程相邻窦性RR间期差值的标准差(SDSD)逐渐增加,而低频功率(LF)与平均窦性RR间期呈进行性降低,差异有统计学意义(P<0.05);SDSD从15 min后开始明显增加,LF从15 min后开始明显降低,而平均窦性RR间期从5 min后开始明显降低。结论RMIVT患者室速的发生与其自主神经功能受损有关,以交感神经激活为主,且有时间依赖性,迷走神经张力变化不明显。Objective To study the sympathovagal balance before the onset of ventricular tachycardia（ VT） in the patients with repetitive monomorphic idiopathic ventricular tachycardia（ RMIVT）. Methods We made ambulatory electrocardiographic recordings from 20 patients with RMIVT. Thirty minutes before the onset of 56 clusters of nonsustained episodes of VT（ preceded by more than 1 hour of sustained sinus rhythm）,we dynamically analyzed the changes of each index of heart rate variability（ HRV） every five minutes. Results Thirty minutes before the onset of VT,the standard deviation of differences between adjacent RR intervals（ SDSD） in full range gradually increased while the low-frequency（ LF） power and the average RR interval in sinus rhythm progressively reduced,all with statistically significant differences（ P 〈 0. 05）. SDSD began to obviously increase after the first 15 minutes while LF started to markedly decrease from the same time point. The average RR interval in sinus rhythm was observed reducing significantly after the first 5 minutes. Conclusion The occurrence of VT in patients with RMIVT is related to the dysfunction of autonomic nerve. It primarily manifests itself by the activation of sympathetic nerve and time-dependence,without obvious change of tension of vagus nerve.

关 键 词：自主神经 特发性室速 心率变异性 

分 类 号：R541.71[医药卫生—心血管疾病]